9610-026 (GRES)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
itk"ii1� i7 �3 � I /S�i3
/ate Signature of ContractorT,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. /U44, Business & Protesslonals Uode).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the `project (Sec. 7044, 'Business & Professionals
Code).
() I am exempt under Section , B&P.C. for this reason
Date Sianature of Owner '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is ss6e`"cU ly`� kers' compensation insurance carrri4*&4p6licy. no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less)'.
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C,o'de, I shall forthwith comply with those provisions.
1/Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for�inspe6on purposes.
AS gnature (Owner/Agent)1-`r a "�— Date 41-'1.
BUILDING PERMIT PERM'CONTROL#
4190
DATE J W 4r96 VALUATION S2,940.W LOT TRACT
JOB ADDRESS I2 t.iV�l�i♦�t�
APN %�—iGi-tt23
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Q
11011►7WARDS CON'S'ktw'[ON '
1225 lI l
79-920 lIESt'A. DKI Y E
) ,A QUINT -A CA 427S3
LA f1i)on'A. C.A. 92253
( -
(00)771.7933 3212
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t; rk.,, F.I,,L,Iii i L't 4LtJl t s1.S,►,Y
USE OF PERMIT
t.EARIN43' 1, (At C'Ajt€'Q016'
79370 ST. IAl(`'1/1. �
Rn l'Y7 A i'lI!'A�A:'fe "A eqgp "
\r21r.�tay sr�.. ra�Waxx�.a a.se .!qtr 1411
2,940.00
PERMIT .";is; 81lMMARV
Ill. AW C14r,e-19, VER 101-00 0,439-318 -318 $:3{.10
C(_,N37'Rt.4_'rl0N FEE lot -W10-08-000
11Lh'(: M I C A L 11.44 ]OI -OW -420-000
'ft')IdCvftiftY!'t( tN i1:ls` - Kkti31.1 101-000-a�11.-000 + E{q
S00- I1:it'r11, CONS.M✓K"TIO N AND VI. Ar N! C11 ECK
S89-00
Lk SS 1"`faii-3'r\i1? i t is
5d3,(l0
TOTAL i'i.Ki�l'C i�.i+;i+x� !ltJir� i�t31�
�t39.f tt
RECEIPT y /
DATE , h tR f BY {
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts '
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final1144
BLOCKWALL P OVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRO ALS =
Gas Test
Electric Final .
Waste Lines
Heater Final
Water Piping 4 YPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures -
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
"
60# 091Z064:_
ti:, t0/01
PGA WEST II RESIDENTIAL ASSOCIATION, INC,
P,O, Box 1282 • La Quinta, CA 92263
September 27; 1996
Ralph J. Rubenstein
Post Office Box -571324
Tarzana,: CA 91357*,
M. PGA WEST II RESIDENTIAL; ASSOCIATION
Architectural Request - 56225 Riviera
Dear Mr. Rubenstein
Thank you for your submittal of architectural plans for a proposed golf cart'garage and
proposed expansion of -the room at the rear of your property. The proposed cart garage
was approved by the A,echitoctural Committee subject to the following conditions;
1) That the. construction of the cart barn comply with all city and building codes,
2). That the cart garage door match that of the existing garage door. .
3) Co,ntcactor must interface with Miguel Valenzuela of Valley Gardening -Services
(399.1844), -the Association's landscape maintenance contractcr, prior to the
commencement of any work on the cart garage, Please have Mr. Edwards show
the proposed landscape pleas to Mr. Valenzuela for his review. -
4) Remittance of a refundable. construction check in the amount of 51;000 made
payable to PGA WEST I1 RESIDENTIAL ASSOCIATION..
�o ° P.�s��QI fRe arding, cporto;ooroom
ap;2te11.-oY-a�t
the rear of the propeirty, the plans `submitted
contained insufficient information from which the Coxxunittee could reach a decisiion, •
i
Please provide the following additional information for the Committee's review;
1) Structural engineering plan from a licensed civil engineer. The Committee has a
concern about the I barring walls on the interior of the house being removed. .
46d
\\monarchiustrshuly�pga2Vubenstein arc -
h 9 20.96.doc
S i : 2 i 10/0.1
RALPH RUBENSTEIN
5EnEMBEkt 27, 1996
PAGE TWO
2) Provide a copy of the plot plan that shows the rear inside yard set backs From the
property lines. eACCUS VW -J ,
3) Please provide the adjacent neighbor approval form from neighbor Kurlander.
4) Please provide lightineandscape/irrigation plan.�y�awn by a ice se 1 dscape
architect. °`T(t�3 g_ wL1,( Pte. ,Qy y. �rL AKc 4:�. "`
.S) Committee visited the site and has.a concetn that the 8' expansion of the room
may have a material impact on'your neighbors to'the north view corridor from
their kitchen patio.. if you have not met with thQ nei8�bor, in persc;rr, walk t 4
site, the Committee or a you to do so * + w�ll�GCd' -}� ,�v� ur t-�,
mac., a wt�s C,o�%r�b • �4K� �y . �i9vt�. srt�s�' o .
Once the above information has been submitted to the Committee it will be reviewed.at .
their next Architectural Meeting on October 15, and notification in writing of . their
decision will be made promptly afier that meeting.
Thank you for your submittal, and should you have any questions please do not hesitate to .
contact me at (619) 360.4161.
Sincerely, i
PGA WEST II .RESIDENTIAL ASSOCIATION
John H. Handel
Association Manager ti
cc: Architectural Committee
Board of.Directors
Unit File